Emotional and cognitive changes in chronic kidney disease

Abstract

Chronic kidney disease (CKD) leads to cognitive impairment and emotional changes. However, the precise mechanism underlying the crosstalk between the kidneys and the nervous system is not fully understood. Inflammation and cerebrovascular disease can influence the development of depression in CKD. CKD is one of the strongest risk factors for cognitive impairment. Moreover, cognitive impairment occurs in CKD as patients experience the dysregulation of several brain functional domains due to damage caused to multiple cortical regions and to subcortical modulatory neurons. The differences in structural brain changes between CKD and non-CKD dementia may be attributable to the different mechanisms that occur in CKD. The kidney and brain have similar anatomical vascular systems, which may be susceptible to traditional risk factors. Vascular factors are assumed to be involved in the development of cognitive impairment in patients with CKD. Vascular injury induces white matter lesions, silent infarction, and microbleeds. Uremic toxins may also be directly related to cognitive impairment in CKD. Many uremic toxins, such as indoxyl sulfate, are likely to have an impact on the central nervous system. Further studies are required to identify therapeutic targets to prevent changes in the brain in patients with CKD.

Does Indoxyl Sulfate Have a Role in Uremic Pruritus? A Laboratory and Interventional Study

“…59,60 In addition, IS can downregulate antiitching mediators such as nuclear factor E2-related factor 2. 61,62 Also, IS is a neurotoxin and can initiate neuroinflammation and induce cognitive impairment and behavioral abnormality, [63][64][65][66][67] which can exacerbate itching. 68,69 All these mediators contribute to non-histamine-induced itching.…”

Association of cognitive impairment with the interaction between chronic kidney disease and depression: Findings from NHANES 2011-2014

“…Frontal lobe cortical atrophy is potentially mediated by WMH burden. CoI is commonly observed in patients with CKD, and various mechanisms, including vascular damage, uremic toxicity, oxidative stress, and peripheral/central in ammatory responses, might damage multiple cortical areas and subcortical neurons, leading to brain dysfunction and subsequent CoI [41][42][43][44]. Therefore, CKD is recognized as one of the strongest risk factors for CoI [45].…”

Body appreciation is associated with optimism/pessimism in patients with Chronic Kidney Disease: Results from a cross sectional study and validation of the Arabic version of the Optimism–Pessimism Short Scale–2

“…Individuals with CKD may experience uid retention, weight uctuations, and changes in body composition, which can result in negative body image and reduced self-esteem [30]. These individuals may experience a sense of disconnect between their perceived self-image and their pre-CKD body, which can contribute to emotional distress and impact their overall quality of life [31].…”